In February 2013 there was a report by Robert Francis QC, into one of the health trusts in the UK (Mid-Staffordshire). Among the findings he listed from an earlier report (February 2010) were the following:
- Patients were left in excrement in soiled bed clothes for lengthy periods.
- Assistance was not provided with feeding for patients who could not eat without help.
- Water was left out of reach.
- In spite of persistent requests for help, patients were not assisted in their toileting.
- Wards and toilet facilities were left in a filthy condition.
- Privacy and dignity, even in death, were denied.
- Staff treated patients and those close to them with what appeared to be callous indifference.
In short there is no doubt that within the health service of the UK, dignity, care and compassion are routinely absent. Some of the stories behind these conclusions make chilling reading: patients forced to drink water out of the vases that contained flowers because their cries for water from the staff went unheeded. In an Accident and Emergency Unit the staff were oblivious to the pain of the patients.
There have, of course, been many responses to this report, and the intention of this article is not to repeat them, but to ask a fundamental question and to see where it leads. The question is, “What is a Human Being?” Some readers will know of Primo Levi’s remarkable book, If This is a Man, based on his experiences of the Nazi concentration camps, and my question is phrased with an awareness of the associations it may beg.
We can talk of the type of training that staff of all levels in a hospital receive, or of targets set by the administrators, of systems of care and so on. But let us get to the very heart of the matter: what image of human being do these staff have in mind? In doing so we do well not to forget that this image is not just of the patients for whom they are supposed to care, but of all human beings, including themselves. The facts indicate that the image is of physical objects, rather than anything with dignity. It is only this surely that can explain how when a patient cries out for water, their cries are ignored hour by hour as their physical condition deteriorates, in some cases until they die of dehydration. They are objects, and the hospital staff are also objects, because there is nothing in them that is stirred by the suffering of another human being for whom they are employed to care.
And we cannot have it any other way: in relationships, the oppressor and the victim are locked into the same categories. If someone for whom you are supposed to care has no dignity in your eyes, then you, yourself, have no dignity. The finger of judgment is always pointing back at the one who judges. To use to words of Martin Buber, in hospitals there were “I – It” relationships, such as there might be between a human being and a tool, or item purchased. There was none of the reciprocity that comes from genuine human interaction, with its feelings of sympathy, empathy, compassion and the like.
So whence this image of human being? Surely from systems, or ways of reading the world that allow humans to become mere physical categories or objects. It is the sort of approach that guides the scientist as she observes physical phenomena. It is the sort of attitude that is used in marketing where statistics prevail over human feelings or stories. It is the sort of attitude that allows the Nazi commandant, or Stalinist guard, or Maoist prison warder to treat prisoners without any regard for the feelings, rights or dignity of the other.
This is not meant to be emotive language, but rather represents an attempt to get to the core of the matter dispassionately. If the other is a statistic then his or her feelings, suffering or cries of pain carry no meaning or significance.
And this leads us to consider a further question: what alternative understandings of human being are there? The answer is that philosophers and religious people have arrived at a quite different view: Christians and Jews would say that human being is in the image of God. Put in another way: each human being is of infinite worth, value and dignity, because they are created by and loved by God their Creator. It follows that we, as humans of such worth, will do all we can to respond to the suffering of another human being.
A story that illustrates this is one told by Jesus and sometimes known as the parable of the Good Samaritan. In the story a man is robbed, beaten up by robbers and left to die. A priest and a Levite each pass by him on the road, and neither takes any notice. They continue their journeys as if nothing has happened. But a Samaritan is moved with compassion. Jesus sees this as the essence of what it is to be a true neighbour: that is a human being in reciprocal and feeling relationship with another human being.
Now there are those who believe that it is possible to derive this idea of human beings as feeling creatures, without recourse to any religious source. If you spell out rights and standards of care, if you educate people properly, then you can deliver a professional and acceptable level of service. History does not confirm this. And it seems to me that humans need to derive an understanding of what it is to be human from a source outside themselves, so that it always transcends any single human being, group or system. If there is no outside reference point it is always possible to compromise standards until a dehydrated person crying out for water is of no consequence.
This is a quite different thing from saying that all religious people are compassionate and kind. Would that it were, and that child abuse had not been revealed as widespread in the churches worldwide. No, a religious commitment is no guarantee of love and compassion. But can we dispense with religious understandings of what it means to be human? I doubt it. If you look at the report you find that there were standards that staff signed up to; there was degree level training for staff. Certainly this did not result in compassionate care for all patients, and it is possible that it made things worse.
Imagine a trained nurse who is charged with gaining and recording information on a patient regularly day or night. She knows how important it is to have accurate records. Is it possible that this knowledge, coupled with the demands of the hospital as a whole for recorded data, means that she will be less inclined to respond to the cries of a patient for help? I have observed situations in wards myself, and the answer seems to be that it is. The reason I give is that non-trained family members visiting another patient seem much more inclined to respond to signs of suffering in other patients on a ward.
Now it could be argued that these family visitors are only there for a short time: the problem is that hospital staff are working week-in, week-out. But isn’t this one of the reasons for training and professionalism?
In China a new set of leaders has been appointed by the Communist Party, and they have made it clear that they are going to be vigorous in their pursuit of corruption. Yet they are simply repeating what all leaders say. The fact is that corruption is endemic in humans and human groups, and without opposition and a free press there is simply no way it can be dealt with. Corruption and one-party states go hand in hand. The slogans against it are merely window dressing.
Likewise there is no way of reinstating care and compassion in hospitals in my view without retrieving a respect for human beings whose source lies beyond rights and standards. It follows that this is true in every area of life, including schools, and social care.
If this sounds depressing, then let me suggest one or two thoughts about a way forward. In hospitals I suggest that there are volunteers appointed to sit in every ward with the sole responsibility of monitoring the quality of care and compassion shown by the staff to patients. They would in effect be advocates for the patients. The fact that they are untrained is of vital importance. Their primary qualification is that they are human beings. Meanwhile I recommend that matrons be reinstated in hospitals charged with raising and maintaining high and sensitive standards of patient care.
Strategically and in the longer term I believe that we will need to consider wherever we should turn again to religious groups to form hospitals, care homes, schools and the like. In times gone by religious beliefs and sensibilities found their way into such places directly or indirectly; now they don’t. So it is that radical change is required.
If it is pointed out that the priest and Levite, though devoutly religious, did not help the wounded man, I cannot but agree. But there is at least an outside and transcendent resource to challenge unacceptable standards of behaviour.
What we cannot do is to assume that this is simply an issue that can be dealt with politically or professionally. It goes to the very heart of what we mean by civilised society. Surely by any standards, a hospital that lets people die because of lack of water or poor cleanliness, is uncivilised. Radical problems call for radical solutions, and that is why I have suggested exactly this.